- Providence (Anchorage, AK)
- **Description** The Inpatient Registered Nurse ( RN ) Care Manager provides professional, comprehensive, patient centric care management services for at ... Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review ,...Associate's Degree in Nursing degree/diploma upon hire + Alaska Registered Nurse License upon hire + 2… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- CVS Health (Dover, DE)
- …RN ) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have ... procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- AmeriHealth Caritas (LA)
- …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in good standing is required. + 3+ ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- CVS Health (Annapolis, MD)
- …administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management / review experience preferred Outpatient Clinical experience. + Knowledge of… more
- SSM Health (MO)
- …Two years' registered nurse experience and three years' utilization management experience, with two years' of demonstrated progressive leadership ... business processes. + Ensures the quality and accuracy of Utilization Management (UM) review decisions,...Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by… more
- Baptist Memorial (Meridian, MS)
- … RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer setting ... Overview RN Utilization Review Weekender Job...Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for… more
- Baptist Memorial (Memphis, TN)
- …Preferred/Desired RN with 3 years of clinical experience RN with Case Management or Utilization Review experience in a hospital or payer setting ... of Position and Scope of Responsibility Job Summary The Utilization Review Nurse is responsible...years of clinical experience RN with Case Management or Utilization Review experience… more
- Covenant Health (Nashua, NH)
- …the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that...to work remotely as needed Education and Experience + Registered Nurse licensed in New Hampshire required… more
- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management . Partners with Social Workers ... . A minimum of three years experience as a registered nurse in acute care for adult...be taken into consideration. . Professional experience with case management , utilization review , or discharge… more
- Guthrie (Binghamton, NY)
- …services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- CVS Health (Annapolis, MD)
- …licenses + Ability to work rotating weekends **Preferred Qualifications** + Managed care/ utilization review experience preferred + Acute care experience + ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Centene Corporation (San Antonio, TX)
- … care services related to mental health and substance abuse is preferred. + Utilization Review / Utilization management with behavioral health cases ... preferred. + Knowledge of mental health and substance abuse utilization review process is preferred. + Experience...- Licensed Marital and Family Therapist required or + RN - Registered Nurse -… more
- Corewell Health (Southfield, MI)
- …degree. + Preferred Bachelor's Degree in nursing or related field. + Hospital utilization review / utilization management experience. Preferred + Clinical ... Scope of Work This role includes accountability for utilization review (UR) and may include...2 years of experience in clinical/hospital setting. Required + Registered Nurse ( RN ) - State… more